Causes and consequences of child growth faltering in low-resource settings

Andrew Mertens (), Jade Benjamin-Chung, John M. Colford, Jeremy Coyle, Mark J. van der Laan, Alan E. Hubbard, Sonali Rosete, Ivana Malenica, Nima Hejazi, Oleg Sofrygin, Wilson Cai, Haodong Li, Anna Nguyen, Nolan N. Pokpongkiat, Stephanie Djajadi, Anmol Seth, Esther Jung, Esther O. Chung, Wendy Jilek, Vishak Subramoney, Ryan Hafen, Jonas Häggström, Thea Norman, Kenneth H. Brown, Parul Christian and Benjamin F. Arnold ()
Additional contact information
Andrew Mertens: University of California, Berkeley
Jade Benjamin-Chung: University of California, Berkeley
John M. Colford: University of California, Berkeley
Jeremy Coyle: University of California, Berkeley
Mark J. van der Laan: University of California, Berkeley
Alan E. Hubbard: University of California, Berkeley
Sonali Rosete: University of California, Berkeley
Ivana Malenica: University of California, Berkeley
Nima Hejazi: University of California, Berkeley
Oleg Sofrygin: University of California, Berkeley
Wilson Cai: University of California, Berkeley
Haodong Li: University of California, Berkeley
Anna Nguyen: University of California, Berkeley
Nolan N. Pokpongkiat: University of California, Berkeley
Stephanie Djajadi: University of California, Berkeley
Anmol Seth: University of California, Berkeley
Esther Jung: University of California, Berkeley
Esther O. Chung: University of California, Berkeley
Wendy Jilek: University of California, Berkeley
Vishak Subramoney: DVPL Tech
Ryan Hafen: Hafen Consulting
Jonas Häggström: Cytel
Thea Norman: Bill & Melinda Gates Foundation
Kenneth H. Brown: University of California, Davis
Parul Christian: Johns Hopkins Bloomberg School of Public Health
Benjamin F. Arnold: University of California, San Francisco

Nature, 2023, vol. 621, issue 7979, 568-576

Abstract: Abstract Growth faltering in children (low length for age or low weight for length) during the first 1,000 days of life (from conception to 2 years of age) influences short-term and long-term health and survival1,2. Interventions such as nutritional supplementation during pregnancy and the postnatal period could help prevent growth faltering, but programmatic action has been insufficient to eliminate the high burden of stunting and wasting in low- and middle-income countries. Identification of age windows and population subgroups on which to focus will benefit future preventive efforts. Here we use a population intervention effects analysis of 33 longitudinal cohorts (83,671 children, 662,763 measurements) and 30 separate exposures to show that improving maternal anthropometry and child condition at birth accounted for population increases in length-for-age z-scores of up to 0.40 and weight-for-length z-scores of up to 0.15 by 24 months of age. Boys had consistently higher risk of all forms of growth faltering than girls. Early postnatal growth faltering predisposed children to subsequent and persistent growth faltering. Children with multiple growth deficits exhibited higher mortality rates from birth to 2 years of age than children without growth deficits (hazard ratios 1.9 to 8.7). The importance of prenatal causes and severe consequences for children who experienced early growth faltering support a focus on pre-conception and pregnancy as a key opportunity for new preventive interventions.

Date: 2023
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DOI: 10.1038/s41586-023-06501-x

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